Welcome to the Nutrition Section.

The nutritional and herbal medicine information is collected from clinical trials and research, as well as traditional uses. It will be regularly updated via seminars. For more information go to Colleges, the National Centre for Naturopathic Medicine and Seminars pages.

This section contains information on Nutrition and Herbal Medicine that reflects current trends and information being presented to the general public. This section is currently and continuously being updated - Stay tuned.

Vitamins

Minerals

Amino acids

Herbal Medicines

For information on herbal medicines, visit the Herbal Page.

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Vitamins

Multivitamins and Minerals

Impact of Trace Elements and Vitamin Supplementation on Immunity and Infections in Institutionalised Elderly Patients

Antioxidant supplementation is thought to improve immunity and thereby reduce infectious morbidity. It is well known that ageing is often associated with a poor immune response, particularly the cell-mediated response, and substantial vulnerability to respiratory tract infections.

This study was performed to determine the effects of long-term daily supplementation with trace elements or vitamins on immunity and the incidence of infections in institutionalised elderly people.
This randomised, double-blind, placebo-controlled intervention study included 725 institutionalised elderly patients (>65 years) from 25 geriatric centres in France. Patients received an oral daily supplement of nutritional doses of trace elements (zinc and selenium sulphide) or vitamins (beta carotene, ascorbic acid, and vitamin E) or a placebo within a 2x2 factorial design for 2 years.

Their results suggest that zinc and selenium supplementation improves the humoral response after influenza vaccine in elderly people. It has been shown that supplementation with the same dose of zinc (20mg/day) leads to a significant restoration of serum thymulin activity in elderly patients. This thymic hormone requires the presence of zinc to express its biological activity and is involved in thymocyte proliferation. The antibody response to influenza vaccine is T-lymphocyte dependent, suggesting that more effective thymulin activity could induce a better anti-influenza response.
Fewer respiratory tract infections were found in patients who received trace elements.
Results of recent studies indicate that vitamin E supplementation may be helpful in the prevention of new heart attacks in patients with coronary disease, as selenium supplementation was in patients with skin cancer.

(Girodon F, Galan P, Monget AL, Boutron-Ruault MC, Brunet-Lecomte P, Preziosi P, Arnaud J, Manuguerra J-C, Hercberg S, and the MIN.VIT.AOX. geriatric network 1999, Impact of trace elements and vitamin supplementation on immunity and infections in institutionalised elderly patients, Arch Intern Med, 159: 748-54.)

The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet

Ageing is accompanied by a variety of physiological, psychological, economic and social changes that compromise nutritional status and/or affect nutritional requirements.

Trials conducted in long-term hospitalised elders with modest doses of antioxidant vitamins have demonstrated their capacity to improve the status of vitamins C and E, ß-carotene and the activities of glutathione peroxidase and/or superoxide dismutase after six months.
In healthy, free-living older adults, clinical trials using multivitamin/mineral supplements have demonstrated improved nutrient status in as little as two months. Significant effects on immune response outcomes such as infectious disease episodes and delayed-hypersensitivity skin test responses have been noted after 12 months of intervention.

An eight-week double-blind, placebo-controlled clinical trial among 80 adults aged 50 to 87 years (mean=66.5±8.6 years) was conducted.

Following the eight-week treatment, subjects taking the supplement had significant elevations in the plasma status of vitamins D (25(OH)D) and E (-tocopherol) of 30% and 21%, respectively.
After eight weeks of treatment, supplemented subjects showed significant improvement in the plasma concentrations of vitamins B6, B12, C, riboflavin, pyridoxal phosphate and folate. Plasma concentrations of pyridoxal phosphate, folate, vitamins B12 and C were increased by 36%, 42%, 14% and 29%, respectively.

Among a group of apparently healthy, free-living older adults consuming an adequate and fortified diet, eight weeks of daily supplementation with a multivitamin/mineral preparation formulated at about 100% daily value for most vitamins significantly improved vitamin status, except for vitamin A and thiamine.
In addition to reducing the prevalence of poor nutrient status, the multivitamin appears to have increased several vitamins into a more optimal range relevant to reducing the risk of chronic disease.

Improving 25-hydroxyvitamin D (25(OH)D) concentrations above the level associated with subclinical deficiency (<37.5 nmol/L) may reduce the risk of developing skeletal fractures due to secondary hyperparathyroidism, lower serum calcium and phosphate levels, higher serum alkaline phosphatase and osteoporosis.

Improving the status of folate, vitamins B6 and B12 is effective in reducing plasma homocysteine, which, in turn, is associated with a reduced risk for vascular disease. The multivitamin intervention increased plasma levels of these B-vitamins sufficiently to have a significant effect in lowering total plasma homocysteine concentrations; however, low plasma levels of folate, B6 and B12 are also associated with an increased risk for heart disease independent of plasma homocysteine concentration. Multivitamin supplementation reduced the prevalence of suboptimal plasma vitamin B12 (>258 pmol/L, p=0.004), but did not shift the mean to the lowest risk quartile (i.e., >335 pmol/L) for coronary atherosclerosis. Eliminating suboptimal plasma pyridoxal phosphate concentrations may have an impact on the risk for atherosclerosis of a 76% increased risk for vascular disease at suboptimal PLP levels.

Supplemental vitamin E treatment has been reported to enhance cell-mediated and humoral immune responses.

The authors concluded that supplementation with a multivitamin supplement, formulated at about 100% Daily Value, can improve micronutrient status in healthy, older Americans to levels above those obtained with a fortified diet. This increase in nutritional status reduces the prevalence of suboptimal plasma vitamin concentrations and will shift blood levels of key nutrients into ranges associated with reduced risk for several chronic diseases.

(McKay DL, Perrone G, Rasmussen H, Dallal G, Hartman W, Cao G, Prior RL, Roubenoff R, and Blumberg JB 2000, The effects of a multivitamin/mineral supplement on micronutrient status, antioxidant capacity and cytokine production in healthy older adults consuming a fortified diet, J Am Coll Nutr, 19: 613-21.)

Daily micronutrient supplements enhance delayed-hypersensitivity skin test responses in older people

It is clear that severe malnutrition or severe deficiencies of specific single nutrients can compromise immune functions and that these can be restored by provision of the appropriate nutrients.

Studies demonstrate that cellular immunity in older people can be enhanced by short-term administration of relatively high doses of vitamin B6 or vitamin E. High doses of ß-carotene have been reported to prevent ultraviolet radiation-induced suppression of delayed type hypersensitivity responses in young adult males and to increase percentages of T helper and natural killer lymphocytes in older adults.

This placebo-controlled double-blind trial of the effects of daily micronutrient supplements on circulating vitamin and trace metal concentrations and delayed-hypersensitivity skin test (DHST) responses was conducted on subjects, aged 59-85 years, were randomly assigned to placebo (n=27) or micronutrient (n=29) treatment groups.
Delayed-hypersensitivity skin test and circulating concentrations of nine micronutrients were measured before and after 6 and 12 months of micronutrient ingestion. For the micronutrient group, there were statistically significant increases at 6 and/or 12 months in the mean serum concentrations of ascorbate (vitamin C), beta-carotene, folate, vitamin B6, and alpha-tocopherol (vitamin E). There was a significant increase at 12 months in the number of subjects in the placebo group with one or more low concentrations.

This study demonstrates that modest daily doses of micronutrients given for 1 year can enhance cellular immunity and can also prevent the development of biochemical evidence of micronutrient deficiencies in healthy, independently living older people.
These results suggest that the dietary micronutrient intake of older people and/or the current RDAs for one or more micronutrients may be too low to support optimal immunity in older individuals.

(Bogden JD, Bendich A, Kemp FW, Bruening KS, Shurnick JH, Denny T, Baker H and Louria DB 1994, Daily micronutrient supplements enhance delayed-hypersensitivity skin test responses in older people, American Journal of Clinical Nutrition, 60: 437-47.)

Folic acid / Folate

One-third of pregnant and lactating women may not be meeting their folate requirements from diet alone

Many women are advised to consume a folic acid-containing prenatal supplement for the duration of pregnancy and lactation.

At mandated levels of fortification many pregnant and lactating women are unlikely to meet their folate requirements from dietary sources alone.

The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States

Since January 1998, the Federal Drug Administration has required folic acid fortification of all enriched cereal-grain products in the U.S. This program intended to increase folic acid intake among women of childbearing age in order to decrease their risk of pregnancies affected by neural tube defects.
Mandatory folic acid fortification led to significant increases in both serum and erythrocyte folate concentrations.
The fortification of enriched cereal-grain products with folic acid led to a significant improvement of blood folate status of the overall adult, non-supplement using, US population. However, women of childbearing age may take folic acid supplements to reach erythrocyte folate levels that have been associated with decreased risk of neural tube defects (NTDs), such as spina bifida.

(Dietrich M, Brown CJ, and Block G 2005, The effect of folate fortification of cereal-grain products on blood folate status, dietary folate intake, and dietary folate sources among adult non-supplement users in the United States, Journal American College of Nutrition, Aug; 24(4): 266-74.)

Screening for vitamin B-12 and folate deficiency in older persons

The clinical presentation of vitamin B12 deficiency varies considerably and rarely includes all the classic features, such as macrocytic anaemia, peripheral neuropathy, and subacute combined degeneration of the spinal cord. More typically, vitamin B12 deficiency presents as non-specific symptoms of fatigue, lassitude, malaise, vertigo, and cognitive impairment that could be attributed to old age.
Folate deficiency also causes macrocytic anaemia but may have neurologic features that differ from those of vitamin B12 deficiency. Accurate identification of vitamin B12 deficiency is important because inappropriate treatment with folic acid will correct the haematologic signs of vitamin B12 deficiency but leave the neurologic symptoms unaltered.

Both vitamin B12 and folate are involved in a common metabolic pathway supplying essential methyl groups for DNA and protein synthesis. Vitamin B12 acts as a cofactor for methionine synthase, the enzyme that remethylates homocysteine to methionine by using 5methyltetrahydrofolate as a methyl donor. Deficiency of either folate or vitamin B12 results in increased serum total homocysteine (tHcy) concentrations. Vitamin B12 also acts as a cofactor for methylmalonyl-CoA mutase, which converts methylmalonyl-CoA to succinyl-CoA; hence, deficiency of vitamin B12 results in elevated serum concentrations of methylmalonic acid (MMA). Consequently, elevated concentrations of methylmalonic acid have been suggested to indicate vitamin B12 deficiency, whereas elevated concentrations of total homocysteine may indicate either vitamin B12 or folate deficiency

BACKGROUND: Vitamin B12 deficiency is usually accompanied by elevated concentrations of serum total homocysteine (tHcy) and methylmalonic acid (MMA). Folate deficiency also results in elevated total homocysteine. Measurement of these metabolites can be used to screen for functional vitamin B12 or folate deficiency.
OBJECTIVE: The authors assessed the prevalence of vitamin B12 and folate deficiency in a population-based study (n = 1562) of older persons living in Oxford City, United Kingdom.
DESIGN: They postulated that, as vitamin B12 or folate concentrations declined from adequate to impaired levels, total homocysteine (or methylmalonic acid) concentrations would increase. Individuals were classified as being at high risk of vitamin B12 deficiency if they had low vitamin B12 (< 150 pmol/L) or borderline vitamin B12 (150-200 pmol/L) accompanied by elevated total homocysteine (> 0.35 micromol/L) or total homocysteine (> 15.0 micromol/L). Individuals were classified as being at high risk of folate deficiency if they had low folate (< 5 nmol/L) or borderline folate (5-7 nmol/L) accompanied by elevated total homocysteine (> 15 micromol/L).
RESULTS: Cutoffs of 15.0 micro mol/L for total homocysteine and 0.35 micro mol/L for methylmalonic acid identified persons with normal or elevated concentrations. Among persons aged 65-74 and >or= 75 y, respectively, approximately 10% and 20% were at high risk of vitamin B12 deficiency. About 10% and 20%, respectively, were also at high risk of folate deficiency. About 10% of persons with vitamin B12 deficiency also had folate deficiency.
CONCLUSION: Use of total homocysteine or total homocysteine among older persons with borderline vitamin concentrations may identify those at high risk of vitamin B12 deficiency who should be considered for treatment.

(Clarke R, Refsum H, Birks J, Evans JG, Johnston C, Sherliker P, Ueland PM, Schneede J, McPartlin J, Nexo E, and Scott JM 2003, Screening for vitamin B-12 and folate deficiency in older persons, American Journal of Clinical Nutrition, May; 77(5): 1241-7.)

This information is presented for your personal educational purposes only. It does not replace or substitute medical advice, nor is it intended to diagnose or treat, and should not be used so. Always consult a health care professional. Use only as directed. If symptoms do persist, or if you are unsure, consult your Health Care Professional. Please read labels carefully. Do not stop taking your medications. Speak to your doctor.